A woman with rheumatic mitral stenosis (MVA 1.0 cm²) becomes pregnant. She is in NYHA class II. She develops increasing dyspnea at 22 weeks despite beta-blocker therapy. The most appropriate intervention is:

• A Emergency cesarean section
• B Mitral valve replacement under cardiopulmonary bypass
• C Diuretic therapy and bed rest until delivery
• D Percutaneous balloon mitral valvotomy ✓

Explanation

Percutaneous balloon mitral valvotomy (PBMV) is the procedure of choice for symptomatic severe mitral stenosis (MVA ≤1.0 cm²) refractory to medical therapy during pregnancy. It can be performed safely under fluoroscopy with lead shielding and avoids the fetal risks of cardiopulmonary bypass. Open cardiac surgery carries significantly higher fetal mortality (15–30%) and is reserved for failed PBMV or unsuitable anatomy.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.